SMACC

Lets explore dogma and myths about the knowledge and skills of 'resuscitationists', and the way we think we maintain and improve our skills.
BLS and trauma team leadership will come under the spotlight - we often don't do what we think we do.
Resuscitationists are exceptional people - but not necessarily in the way we think we are.
And finally - some thoughts on what we'll leave behind as resuscitationists... with a tribute to John Hinds

Direct download: So_You_think_youre_a_Resuscitationist.mp3
Category:general -- posted at: 9:00pm AEST

Agitation poses a direct threat to the safety of both patient and staff, as well as being an important manifestation of dangerous conditions that require rapid identification and treatment. Management of agitation consists primarily of physical and chemical restraint, and the details of how restraint is carried out–usually based more on tradition than considered plans or thoughtful protocols–directly determine case outcome. In this talk, we’ll discuss the initial approach to agitation, focusing on the appropriate role of physical restraint, as well as best practice technique for physical restraint. We will then deliberate the options for chemical sedation and propose a menu of the safest and most effective agents for a variety of common agitation scenarios. Some of the questions we will address include: What are the most important dangerous conditions that cause–or are caused by–agitation? What are dangerous restraint holds, and how can physical restraint be accomplished in the safest manner? In the initial management of an agitated patient, should chemical restraint be administered by the intravenous or intramuscular route? How do haloperidol and droperidol compare speed in efficacy when used for calming the agitated patient? How should providers manage concerns around prolonging the QT interval when using butyrophenones for sedation? Which benzodiazepine is preferred, as a treatment for agitation? How should neuroleptics and benzodiazepines be used as monotherapy or in combination? In which type of patient should ketamine be used as a sedation agent? How should ketamine be dosed for tranquilization, and what adverse effects should providers be mindful of when using ketamine for this indication? Can ketamine be used in patients with hyperdynamic vital signs? What is the role of crystalloids in managing the agitated patient? Once the agitated patient has been calmed, what are the primary, secondary and tertiary resuscitative maneuvers (diagnostics and therapeutic)?

Direct download: disruption_danger_and_droperidol.mp3
Category:general -- posted at: 9:00pm AEST

As our population ages, the complexity of patients seeking care in the emergency department will increase dramatically. Chronic and terminal diseases will be ever-present but increasingly in patients also negotiating challenges like functional and cognitive decline. While their needs are different, in many hospitals, it is business as usual. A highly skilled and well-intentioned staff stands ready to deploy a limitless supply of diagnostic and therapeutic options designed to help patients live longer, not necessarily better.

Relying on default pathways that prioritize life-prolongation at the mercy of comfort and dignity has already left many patients and doctors feeling unsatisfied, while wasting precious healthcare resources. The future should not be more of the same.

If a new and better clinical road is to be paved in the future, it will be with the aid of palliative care, a specialty, philosophy and movement in medicine. Getting patients better access to palliative care should be a priority for our specialty. For some, this will mean partnering with existing palliative care specialists and hospices. Unfortunately, for most of us, the palliative care workforce will never be able to match the increasing demand created by our patients. This means that we must all do the hard, but incredibly rewarding work of learning a basic palliative care skillset. No pressure but the future of healthcare depends on it!

Direct download: Why_we_need_palliative_care_everywhere.mp3
Category:general -- posted at: 9:00pm AEST

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